Page 10 - 2016 Enrollment

10

Vision

Vision coverage is transitioning NOTE—Vision beneit deductions are taken on a pre-tax basis.

from DeltaVision to Cigna. Cigna Vision Contributions—Monthly
utilizes the VSP network and also Employee only $7.55
provides access to retail providers Employee + spouse $15.09
such as LensCrafters, Pearle Employee + child(ren) $15.24
Vision, JCPenney, Target, etc. The Family $24.33
vision plan covers routine eye
exams and also pays for a portion Cigna/VSP

of the cost of glasses or contact In-Network Out-of-Network
lenses. Vision Exam
$10 copay Reimbursed up to $45
To ind an in-network Lenses

vision provider, please visit Single $15 copay Reimbursed up to $32
www.cigna.com, click on the Bifocal $15 copay Reimbursed up to $55
Reimbursed up to $65
$15 copay
Trifocal
orange “Find a Doctor” tab Lenticular $15 copay Reimbursed up to $80
at the top, then select “Vision Frames
Directory—Routine Eye Exam & $200 allowance; 20% Reimbursed up to $110
Eyewear” from the directory list. discount on amount
over $200
Contacts
Elective $200 allowance Reimbursed up to $160
Medically required Covered in full $210 allowance
Frequency
Exam Once every 12 months
Lenses Once every 12 months
Contacts Once every 12 months
Frame Once every 24 months

Note: contacts must be in lieu of lenses and frames. Beneit frequencies reset on a calendar
year basis.

Each employee with receive two personalized ID cards for vision coverage,
mailed to your home address.

Fontbonne University